Primary Care

Do physician assistants and nurse practitioners really save money?

Policy
January 24, 2015

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In his popular tome, The Innovator’s Prescription, Clayton Christensen proposes several cures to health care’s cost disease, known as disruptive innovations. One is the replacement of physicians by advanced practice clinicians (APCs). That is, by nurse practitioners and physician assistants. APCs meet the requirements for Christenson’s disruptive innovators: They cost less (than physicians) and are good enough.

There is little doubt that APCs …

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Professionalism: A commitment to lifelong learning aimed at the care of the patient

Physician
January 23, 2015

I am a doctor today because of Dr. J.W. Epstein, my pediatrician in Cleveland in the 1950s. An immigrant from the Nazi terror in Europe (it was family lore that he had escaped the Holocaust), he had trained in Vienna and spoke English with a Germanic accent. His house calls are etched permanently in my memory. His visits were heralded by a fury of activity, led by my mother. “The …

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Why other professions can’t relate to medicine

Physician
January 15, 2015

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Doctors have a difficult time adjusting to other cultures and because of this flaw, patients, and the medical profession suffer.  By culture, I do not mean religious or philosophical background, socio-economic difference, country of origin, nor even the silence created by language and education barriers.  I am referring to the communication and comprehension chasms that exist between different occupations and physicians.

What …

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Physicians must unionize. Here’s why.

Physician
January 12, 2015

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If F. A. Hayek were alive today, he would support the revival of labor unions in general and professional labor unions in particular. Towards the end of the Second World War, Hayek wrote a book warning us all that allowing governments to engage in extensive central planning of economic activities is nothing more than a road to serfdom for humanity. F.A. …

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A physician investigates the American Board of Internal Medicine

Physician
January 7, 2015

Is it medically professional for a non-profit organization to use physician testing fees to “choose wisely” a $2.3 million luxury condominium complete with a chauffeur-driven BMW 7-series town car? In my view, obviously not. To most people, such an action would conjure up images of hypocrisy, waste, and corruption.

After a review of public and tax records, it appears to me this is exactly what has happened.

Background

In 1999 for reasons that …

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A prescription to treat polyprovider syndrome

Physician
January 4, 2015

In the United States, we train health care providers on poor people. This is no secret — most medical schools and residencies are in lower income areas. If you have Medicaid or no insurance, you are more likely to find care in an office or hospital where medical students, residents, nursing students, and other trainees rotate; Blue Cross patients don’t let interns watch their childbirth. Even though my residency emphasized …

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How the kind, humble physician met his demise

Physician
December 30, 2014

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There once was a kind, humble physician who worked for years in an office building across the street from the hospital, toiling day to day to take exceptional care of his patients.  He was open and deliberate, calm and thoughtful.  He himself hired every secretary and medical assistant, every nurse, and biller.  His staff formed a protective family who fiercely advocated …

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Dear HMO, I don’t want your money

Physician
December 24, 2014

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Dear HMO,

As I prepare to #getcovered or #staycovered, I realize that as a physician, I have an advantage in that I know what specific types of insurance plans would best fit my needs.  Unfortunately, this is not the case for many Americans.  Most importantly, I know to avoid signing up for certain health maintenance organizations (HMOs).  Although I am a strong …

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Medicine is complex, but doctoring is viewed as being simple

Physician
December 14, 2014

I keep six honest serving-men
(They taught me all I knew);
Their names are What and Why and When
And How and Where and Who.
– Rudyard Kipling

Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done.

What else could explain why IT people tell doctors what “workflows” …

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A doctor goes networking, and is horrified by what she finds

Physician
December 11, 2014

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I was invited to a “networking party.” I went. I was horrified by what transpired there. And disgusted. And felt blindsided. And angry. And blown away by the prevalence of what I couldn’t decide was greed, ignorance, or an unseemly combination of the two. And what magnified the intensity of my repulsion was the fact that a large proportion of the people involved have the …

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After residency: I’m scared to practice outpatient medicine

Education
December 3, 2014

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As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this?

Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient …

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Why teaching anatomically correct words matters

Physician
December 2, 2014

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As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals.

In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have …

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Two patient result letters: Which one did this physician send?

Physician
December 2, 2014

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Middle-aged lady, twenty pounds overweight.

Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.

Yada, yada, yada.

Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …

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Medicare will pay for care coordination. Should doctors take the money?

Policy
December 1, 2014

CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients.  When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …

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Consider the lipstick sign in your next physical exam

Conditions
December 1, 2014

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The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning.

Fine motor skills and concentration can be correlated with a positive …

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It’s time to tell fast medicine to slow down

Physician
November 11, 2014

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Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals …

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When you can’t share experience: The power of listening

Physician
November 11, 2014

I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference — she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through.

I have a different thought.

Although every experience …

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